Examination of GI system Flashcards
Overview of examination of GI system
Inspection
Palpation
Percussion
Auscultation
Before you begin what do you have to do?
Wash your hands
Introduce yourself
Explain what you would like to do and ask for permission
Ask patient have they any questions
Chaperone
Exposure
What do we do in inspection?
Inspect in a systematic manner – start from the end of the bed and work your way from the hands to the face, neck, chest then abdomen
Assess the bed space too! – look for drip stands, catheter bags, inhalers etc
What can we realise from the end of the bed?
Is the patient in obvious discomfort or distress?
- Pain
- Tachypnoeic
- Jaundiced/cyanosed
Body habitus
Check the observation chart
Check the fluid balance chart
Koilonychia is shown in what
Fe deficient anaemia
Leukonychia is seen in what?
hypoalbuminaemia, liver cirrhosis
What is nail clubbing seen in?
Nail clubbing – resp, cvs and GI conditions (crohns, UC, cirrhosis)
Causes of palmar erythema?
many causes, portal hypertension and cirrhosis in GI tract
What is dupuytrens contracture seen in?
alcoholism and liver disease
How do we look for a liver flap?
Ask patient to extend their arms out with palms up
How to look for jaundice?
Ask patient to pull down their eyelid
What is xanthelasma?
Eye skin things
Kayser - Fleischer rings are found in…
Wilsons disease
What can be found in the mouth?
Angular cheilitis - spots on side of mouth - Fe Deficiency
Glossitis - Swollen red tongue
Mouth ulcers - red spots in mouth
What is found on inspection of the chest?
Spider naevi
SVC distribution
Gynaecomastia
Supraclavicular lymph node
What to do on inspection of the abdomen?
Ask the patient to lie flat with their hands beside their sides
Describe any scars, stomas, lesions, masses or obvious signs
Comment on whether the abdomen is distended
Don’t forget to mention the presence of drains, catheters etc!
Description of abdominal scars
Rooftop
Hypochondrial
Upper midline
Lower midline
Paramedian
Gridiron
Pfannenstiel
Slide 24 on examination of GI system great picture
What to comment on for stomas?
Site
Type of bowel
Content
Type of Bag
What are the different signs seen on the abdomen?
Cullens sign - bruises near belly button - pancreatitis
Grey’s- Turner sign- Bruises on the side of abdomen - pancreatitis
Caput medusa - portal hypertension
How do we palpate the abdomen?
Get down to the patient’s level
Palpate superficially then deep in all 9 regions on the abdomen
Start with the region that is further away from the area that is painful
Palpate the liver, spleen and ballott both kidneys
Palpate for a bladder and abdominal aorta
How do we palpate?
Hand flat over each area and flex at the MCP joints
Look at the patients face, not at your hand
How do we palpate the liver?
Deep breaths
Palpating hand will feel liver pushed down by the diaphragm in inspiration
Liver can be palpated up to 1cm below the right costal margin on deep inspiration
Gallbladder not normally palpable unless enlarged
What is Murphy’s sign?
Ask the patient to exhale
Place hand in right upper quadrant just below costal margin
Ask the patient to inhale
Is positive if the patient is sore/catches breath on inhaling and is possibly a sign of cholecystitis
How do we palpate the spleen?
Not normally palpable unless enlarged
Can place left hand posteriorly and roll patient slightly towards you
Begin in the right iliac fossa
Advance towards the left costal margin
How do we ballot the kidneys?
Anterior hand lateral to the margin of the rectus in the upper quadrant
Posterior hand in the costovertebral angle to lift the kidney up against the anterior hand
Lower pole right kidney may be palpable in thin people, left kidney rarely palpable
Slide 33 of examination of GI system
Big spleen features
Can’t get above
Can cross the midline
Sometimes can feel a splenic notch
Moves down on inspiration
Cannot ballott the spleen
Big Kidney features
Can get above
Doesn’t cross the midline
Doesn’t move on respiration
Ballotable
Palpate the abdominal aorta
Aortic pulsation may be felt in a normal thin person
Palpate for a distended bladder
The bladder is only palpable when it has >300ml of urine
The patient may describe the sensation of needing to pass urine on palpation of a full bladder
What is Rovsing’s sign?
Palpation of the left iliac fossa results in pain in the right iliac fossa
Can indicate appendicitis
Where is percussion found of the liver?
percuss downwards from superior border of 6th rib then upwards from umbilicus in midclavicular line
Where is percussion found from the spleen?
percuss in the left anterior axillary line, lowest intercostal space, if changes from resonant to dull on inspiration then splenomegaly
Where is percussion of the bladder found?
from pubic symphysis to umbilicus
How do you examine shifting dullness?
Palpate abdomen at midclavicular line where you detect dullness and then move over to a different area of the patient to see if the dullness is shifting elsewhere
What do you do on auscultation?
Listen for bowel sounds and describe them
Listen for aortic and femoral bruits
How do we complete the examination? (ISHRUG)
Inguinal lymph nodes
Stools
Hernial Orifices
Rectal Examination
Urinalysis
Genitalia
What do we do at the end?
Thank the patient
Ask them to redress
Wash your hands!
How to do a per rectal examination?
Left lateral position with knees tucked up towards chest
Inspect the perianal area for any lesions
Insert a gloved well-lubricated finger
Assess anal tone
Assess rectum for stool or masses
Assess size and feel of the prostate
Check the gloved finger for blood after removing
How do we examine the scrotum?
Inspection
Scrotal skin
Lie of the testis
Palpation
- Gentle pressure to palpate the testes, epididymis and cord
Transillumination
-using a pen torch
How to differentiate between the causes of scrotal swellings?
Can I get above the swelling?
Can I identify a normal testis?
Is the swelling tender?
Does the swelling transilluminate?
Scrotal swelling - Can i get above the swelling?
NO - (Not a true scrotal swelling)
Infantile hydrocele
Hernia
Yes - True scrotal swelling
(PROCEED TO NEXT QUESTION)
Scrotal swellings - Can I identify a normal testis?
No -Testicular Tumour, Tense Hydrocele, Orchitis
Yes - NOT A TESTICULAR MASS
(PROCEED TO NEXT QUESTION)
Does the swelling transilluminate in scrotum? (Normal testis)
No - Spermatocele
Epididymitis
Epididymal tumour
Tuberculous epididymitis
Yes - Epididymal Cyst
Cyst of the cord
Lax hydrocele
Does the swelling transilluminate in scrotum? (NO Normal testis)
No - Testicular Tumour
Haematocele (smooth surface, history of trauma
Orchitis (tender)
Yes - Hydrocele
